Irregular Menstruation: When to Seek Further Gynecological Care

Irregular menstruation?

Hello Dr.
Chang, I would like to ask you a question.
My usual menstrual cycle is every 31 to 35 days.
My last period started on February 27.
During this cycle, I took influenza medication, and I was receiving injections and medication throughout March.
I expected my period around March 29, but it did not come.
I have not had any sexual intercourse.
On April 5, I visited a gynecologist, and after an ultrasound, the doctor indicated that my endometrium was thick enough to induce menstruation.
I took the medication to induce menstruation for two days, but my period still did not arrive.
Therefore, on April 12, I returned for a check-up and took a pregnancy test, which was negative.
I then received an injection to induce menstruation.
On April 13, I noticed a small amount of very dark menstrual blood, similar to the color seen in the last couple of days of my period.
Does this count as my period? Do I need to return to the gynecologist for another injection? Thank you.

CC, 20~29 year old female. Ask Date: 2016/04/13

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, it is recommended to return for a follow-up appointment for the physician to examine and assess whether everything is normal.
Thank you! Wishing you peace and health.
Dr.
Chang.

Reply Date: 2016/04/13

More Info

Irregular menstruation can be a complex issue, especially when influenced by various factors such as medications, hormonal changes, and underlying health conditions. In your case, it appears that you have experienced a significant disruption in your menstrual cycle, which has raised concerns about your reproductive health.
Firstly, it is important to understand what constitutes a normal menstrual cycle. A typical cycle ranges from 21 to 35 days, with menstruation lasting between 2 to 7 days. Your cycle of 31 to 35 days falls within this normal range. However, the absence of menstruation (amenorrhea) for a month, particularly after taking medications for flu, can indicate a temporary disruption in your hormonal balance.
The medications you were taking for the flu, including any injections, could have affected your menstrual cycle. Certain medications can influence the hypothalamic-pituitary-ovarian axis, which regulates the menstrual cycle. Stress, illness, and changes in routine can also contribute to irregularities.
When you visited your gynecologist on April 5th, the ultrasound indicated that your endometrial lining was sufficiently thick, which is a positive sign that your body was preparing for menstruation. The administration of medication to induce menstruation is a common practice when there is a delay, and it seems that you were given a two-day course of such medication. However, the fact that you did not menstruate after this treatment suggests that your body may still be adjusting to the hormonal changes or the effects of the medications you were on.

On April 13th, you experienced a small amount of dark-colored blood, which is often associated with the tail end of a menstrual period. This could indeed be considered a menstrual flow, albeit a very light one. The color of menstrual blood can vary, with darker shades typically indicating older blood that has taken longer to exit the uterus.
As for whether you need to return to your gynecologist for further treatment, it depends on how you feel and whether the bleeding continues. If the bleeding stops and you do not experience any other concerning symptoms (such as severe pain or heavy bleeding), it may not be necessary to seek further care immediately. However, if you continue to have irregular cycles, experience significant pain, or have any other symptoms that concern you, it would be wise to follow up with your gynecologist.

In summary, while your recent experiences with irregular menstruation and the effects of medication can be concerning, they are not uncommon. It is essential to monitor your symptoms and maintain open communication with your healthcare provider. If your menstrual cycle does not normalize in the coming months or if you have any additional concerns, do not hesitate to seek further evaluation. Regular check-ups can help ensure that any underlying issues are addressed promptly, allowing you to maintain your reproductive health.

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